| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1017 |
Targeted case management, each 15 minutes |
2,533 |
1,672 |
$634K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,058 |
997 |
$66K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,133 |
1,107 |
$45K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
314 |
311 |
$30K |
| D0191 |
|
1,008 |
1,005 |
$19K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
250 |
246 |
$10K |
| 90461 |
|
205 |
202 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
377 |
360 |
$6K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
492 |
464 |
$6K |
| 0001A |
|
89 |
86 |
$3K |
| D1351 |
Sealant - per tooth |
144 |
35 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
36 |
36 |
$3K |
| 0002A |
|
82 |
78 |
$3K |
| 90686 |
|
363 |
361 |
$2K |
| 90674 |
|
74 |
73 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
67 |
54 |
$838.07 |
| 81025 |
|
128 |
126 |
$705.17 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
13 |
13 |
$384.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
12 |
12 |
$352.00 |
| 0124A |
|
13 |
13 |
$340.00 |
| 88142 |
|
14 |
13 |
$292.63 |
| 90656 |
|
17 |
17 |
$195.69 |
| 87210 |
|
19 |
19 |
$95.08 |
| 83986 |
|
16 |
16 |
$60.28 |
| 90662 |
|
13 |
13 |
$48.03 |
| 90734 |
|
39 |
39 |
$0.38 |
| 90715 |
|
30 |
30 |
$0.30 |
| 90651 |
|
37 |
36 |
$0.18 |
| 91300 |
|
204 |
181 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
796 |
794 |
$-393.43 |